Provider Demographics
NPI:1730146887
Name:WHEELER, JOE ELLIS (MD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:ELLIS
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 W ROSEDALE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:817-335-3966
Mailing Address - Fax:817-335-7926
Practice Address - Street 1:1650 W ROSEDALE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-335-3966
Practice Address - Fax:817-335-7926
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1855207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154007-01Medicaid
TXOONO6 EMedicare ID - Type Unspecified
TX1154007-01Medicaid